Objective This study aims to appraise 2017 AACE Guidelines for Management of Dyslipidemia and Prevention of Cardiovascular Disease by using Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. Method A total of seven investigators who have obtained a postgraduate Doctor of Pharmacy or Masters of Clinical Pharmacy, appraised the dyslipidaemia guidelines independently, by using AGREE II tool. Key findings Among all the domains, the highest-scoring domain was the clarity of presentation (87%), and the lowest was the applicability (26%). The assessors gave the top ranking for both 'scope and purpose' (78%) and 'Editorial independence' (79%). The overall guideline assessment was 61%. Most of the investigators (four out of seven) recommended using the guidelines in clinical practice with modifications. Conclusion The appraisal obtained in this article can be utilized by guideline developers to improve the quality of their upcoming guidelines. Healthcare professionals can be aware of guideline limitations and the importance of quality assessment of the guideline before applying their recommendations whenever possible by using Agree II tool.

There is no strong evidence on pharmacogenetics role on the quality of INR control after the initiation phase and on the maintenance of stable INR on the long term as measured by the time in therapeutic range (TTR). The benefit of a score such as SAMe-TT 2 R 2 is that it can preemptively guide clinicians on whether to start the patient on warfarin or direct oral anticoagulant. To determine the association between genetic variants in CYP2C9, VKORC1, and CYP4F2 and TTR. To validate SAMe-TT 2 R 2 score predictive ability on the quality of anticoagulation in Qatari patients. This is an observational nested case-control study that was conducted on a cohort of Qatari patients treated with warfarin with previously identified genotype for the CYP2C9, VKORC1, and CYP2F4. The sample size of this cohort was 148 patients. Mean TTR was 62.7 ± 21%. TTR was not significantly different among carriers of the CYP2C9*2 &*3, VKORC1(-1639G>A) or CYP4F2*3 compared to their non-carriers alleles. None of the factors in the SAMe-TT 2 R 2 score had a significant effect on the TTR except for the female gender where TTR was significantly lower in females (n = 89) compared to males (n = 59) (59.6 ± 21% vs. 67.2 ± 20%, p = 0.03). Furthermore, patients with SAMe-TT 2 R 2 score of zero had significantly better TTR compared to those with higher scores (76.5 ± 17% vs. 61.8 ± 21%, p = 0.04). Logistic regression analysis showed that high SAMe-TT 2 R 2 score was the only statistically significant predicting factor of poor INR control (odds ratio (OR) 5.7, 95% confidence interval (CI) 1.1-28.3, p = 0.034). Genetic variants have no contribution to the quality of INR control. SAMe-TT 2 R 2 score was predictive for the poor quality of anticoagulation in a cohort of Qatari patients. Keywords Same-TT 2 R 2 • Pharmacogenetics • Warfarin • Direct oral anticoagulants • Time in therapeutic range Highlights • SAMe-TT 2 R 2 is a tool that can preemptively guide clinicians on whether to start the patient on warfarin or direct oral anticoagulant. • There is no strong evidence on pharmacogenetics role on the quality of INR control and TTR after the initiation phase. • This research shows that genetic variants have no contribution to the quality of INR control. • Our results also indicate that SAMe-TT 2 R 2 score is predictive for the poor quality of anticoagulation in a cohort of Qatari patients.

This case report describes a possible unknown complication of morphine withdrawal in a patient with persistent back pain, treated with intrathecal morphine pump infusion. The patient presented with left lower extremity edema. After excluding deep vein thrombosis by Doppler ultrasound and worsening of the swelling despite oral antibiotics, peripheral edema caused by intrathecal morphine was suspected. Twelve hours following the termination of his intrathecal morphine pump and initiation of inequivalent doses of oral morphine and tramadol, he developed convulsions. After metabolic and structural causes of convulsion were ruled out by blood tests and head imaging, equivalent doses of morphine were given. Then the patient regained full consciousness, and no additional seizures occurred. After that, opioid withdrawal emerged as the most likely explanation. Seizure is a life-threating condition; therefore, an awareness of this case is important and further studies are warranted to explore the potential association of opioid withdrawal and seizure. PubMed Abstract | Publisher Full Text | Free Full Text 3. Jain S, Singhai K, Swami M: Seizure as a primary presentation in opioid withdrawal. Psychiatry Clin Neurosci. 2018; 72(10): 802-803. PubMed Abstract | Publisher Full Text 4. Herzlinger RA, Kandall SR, Vaughan HG Jr: Neonatal seizures associated with narcotic withdrawal. J Pediatr. 1977; 91(4): 638-641. PubMed Abstract | Publisher Full Text 5. Zelson C, Rubio E, Wasserman E: Neonatal narcotic addiction: 10 year observation. Pediatrics. 1971; 48(2): 178-189. PubMed Abstract 6. Kandall SR, Gartner LM: Late presentation of drug withdrawal symptoms in newborns. Am J Dis Child. 1974; 127(1): 58-61. PubMed Abstract | Publisher Full Text 7. Pinsky C, Dua AK, LaBella FS: Peptidase inhibitors reduce opiate narcotic withdrawal signs, including seizure activity, in the rat. Brain Res. 1982; 243(2): 301-7. PubMed Abstract | Publisher Full Text 8. Webster LR, Webster RM: Predicting aberrant behaviors in Opioid-treated patients: preliminary validation of the Opioid risk tool. Pain Med. 2005; 6(6): 432-442.PubMed Abstract | Publisher Full Text life-threating condition; therefore, an awareness of this case is important and further studies are warranted to explore the potential association of opioid withdrawal and seizure.

fatal consequences. Missing dependent and independent controls regarding concentration and identity pose a risk for patient safety. Purpose We developed a concept for a two-stage quality control of the infusion solutions. Drug identity and concentration can be checked onsite after preparation using a combined UVand Raman spectrometer (UV-Raman). This is complemented by an independent method using liquid chromatography coupled to UV detection (HPLC-UV). Material and methods Methods for the analysis of seven cytostatic drugs and two monoclonal antibodies were developed and validated on an i-QCRx UV-Raman system (B and W Tek Europe GmbH, Lübeck, Germany) and on an Agilent 1200 series HPLC-UV system (Agilent Technologies, Waldbronn, Germany). Sample transport and preparation were evaluated to ensure valid results. In a pilot study we analysed samples from different pharmacies in both systems. Results Method development and validation were successful for the investigated compounds in both systems. HPLC-UV is more sensitive than UV-Raman. However, due to the content of the preparations, real samples had to be diluted before applying HPLC-UV analysis. Sensitivity of the UV-Raman spectrometer fits to the required concentration range without further dilution. All methods showed reproducible results, UV-Raman varied by 0.44% in a repeated analysis (n=3) of 5-fluorouracil, while HPLC-UV varied by 0.14%. Results of the investigated samples were also equivalent. In a sample containing paclitaxel with a target concentration of 0.72 mg/mL we determined 0.73 mg/mL (101%) using UV-Raman and 0.69 mg/mL (96%) using HPLC-UV, for example. Conclusion UV-Raman and HPLC-UV are suitable for determining the content of patient-individual preparations, both with individual assets and drawbacks. The study showed that the two-stage control concept is appropriate to ensure a highquality level for patient-individual preparations.